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Medicaid Drug Spending Dashboard

Targeted News Service (Press Releases)

WASHINGTON, Nov. 14 -- The U.S. Department of Health and Human Services' Centers for Medicare & Medicaid Services issued the following fact sheet:

Medicaid is a state-federal partnership that provides health insurance to over 73 million beneficiaries and spent approximately $57 billion on prescription drugs in 2015. The Centers for Medicare & Medicaid Services (CMS) released a new online dashboard to look at Medicaid spending on covered outpatient drugs, as part of CMS' effort to provide additional information on and increase transparency with respect to the cost of prescription drugs. Although the dashboard presents data on a relatively small number of drugs, these drugs represent approximately 41% of Medicaid covered outpatient drug spending in 2015.

This online dashboard presents information for three categories of Medicaid prescription drugs: drugs with high spending for the program overall, those with high average spending on a per prescription fill basis, and those with high unit cost increases in recent years. The dashboard provides trend analyses as well as additional detailed information on each drug, such as drug spending, number of prescription fills, brand and generic name, uses (drug information CopyrightS First Databank, Inc.), and the name of the manufacturer.

CMS identified the 70 drugs included in the dashboard using 2015 data. CMS included all drugs that met one of the following criteria:

1. The 25 drugs with the highest total spending;

2. The 25 drugs with high average spending per prescription fill ($1,000) and with the highest total program spending (if a drug already is selected based on (a) it is not eligible to be selected based on (b) criteria); or

3. The 20 drugs with large increases in average cost per unit from 2014 to 2015 (if a drug already is selected based on (a) or (b) it is not eligible to be selected based on (c) criteria).

The data presented in the dashboard reflect payments to pharmacy providers for a drug, and do not reflect the rebates that states receive under the Medicaid Drug Rebate Program or under state supplemental rebate agreements. CMS is prohibited from publicly disclosing drug-specific information related to manufacturer rebates. However, the spending data presented in the dashboard are important because they reflect pharmacy-level prices for prescription drugs from pharmacies.

This list is intended to make the trends related to high-cost drug spending for Medicaid beneficiaries transparent to providers, consumers, and the public. In addition to the goal of transparency and the potential use of the information to educate the public, the data can be used to spur research and public discussion of how these drug products are being used in Medicaid and the costs associated with those uses.

Chart 1 below shows the trend in total drug spending for the five drugs with the highest aggregate drug spending in the Medicaid program in 2015. The top five drugs were Abilify (aripiprazole; a brand name anti-psychotic drug), Harvoni (ledipasvir/sofosbuvir; a brand name Hepatitis C virus treatment), Humira/Humira Pen (adalimumab; a brand name drug used for rheumatoid arthritis), Lantus/Lantus Solostar (insulin glargine; a brand name diabetes drug), and Vyvanse (lisdexamfetamine dimesylate; a brand name attention deficit hyperactivity disorder drug). Harvoni, which was introduced in 2014, and Abilify had total drug spending greater than $2 billion in 2015, with annual total program spending for Abilify greater than $1.7 billion for each of the past 5 years. In 2015, spending for Lantus/Lantus Solostar was $1.4 billion and spending for Vyvanse and Humira/Humira pen was approximately $800 million each.

Chart 1. Trends in Medicaid Total Spending for the Top 5 Drugs in 2015.

Chart 2 below displays the top five drugs selected for high costs per prescription fill ($1,000) with the highest total Medicaid spending in 2015. Advate (antihemophilic factor [recombinant], a brand name hemophilia treatment) had an average cost per fill of $20,828 and was associated with total program spending of $354 million. In comparison, Prezista (darunavir ethanolate, a brand name HIV antiviral) had an average cost per fill of $1,259 and total program spending of $335 million. NovoSeven RT (coagulation factor VIIa [recombinant]; a brand name hemophilia treatment) had the highest average cost per fill at $67,098 and $298 million in program spending.

Chart 2. Drugs with High Average Medicaid Spending per Prescription Fill and High Total Medicaid Spending, 2015.

For drugs selected due to their cost increases with large impacts to the Medicaid program, chart 3 below shows the top five drugs with the largest increases in average cost per unit from 2014 to 2015. Ativan (lorazepam; a brand name drug used for anxiety), had the largest increase in cost per unit at 1,264 percent and a spending increase from $1.7 million to $5.3 million. All five of these drugs had increases in cost per unit of more than 400 percent.

Chart 3. Drugs with Large Increases in Average Medicaid Cost per Unit, 2014 to 2015.